I am a 73 year old semi retired nurse educator and still teach and travel. Long ago I worked in ICU/CCU and have had experience in long term care, have been a hospital supervisor, etc.
Feet first? I have cared for senior people who by and large peacefully died after refusing feeding tubes and IVs at home. A living will and a lawyer to obviate the will of relatives who may have their emotional needs up front, not yours, is a necessity. I have had cancer, 30 plus years ago and survived nicely. But aging in the illness mix, not youth, is another thing entirely. Yes, saying a quiet good bye in my own bed is what I want. After an age I determine with a situation I determine, no more intervention. Too much money is spent grasping at a waning barely liveable life. Pain meds only and a time to die. I pray to God I can make it happen.
52
Consider the risks with significant buy ins of bankruptcy by the provider, unrestrained increases in monthly fees, deficiencies in the quality of the care provided over time, the loss of benefits in the event of a move...
22
Saying you will only leave the house feet-first isn't a plan. In my area, two doctors who helped found the medical school said the same thing. But they actually did leave the house feet-first. How, by refusing all treatment for heart conditions. I find Canadians more pragmatic. The "common good" health care principal. We have greatly expanded our medical aid in dying in the last couple of years. It now even includes early Alzheimer's so that's what I will choose.
16
As the comments here attest, the issues and needs are complex and vary greatly depending on individual circumstance. Having government policy and/or institutional offerings (be they for profit or non profit) that work for all is very unlikely.
5
Anyone wanting more information about seniors living at home or whatever, check out Fairfax County Government that provides lots of information about this topic and more
8
I would be very skeptical of these arrangements. CCRCs require very large up front payments, and as noted the monthly feed in addition to that can be significant. First of all it is clear they are not geared toward the average retiree. Unless a person sells their home and "reinvests" all the money in a CCRC very few people the funds to pay upfront. The monthly requirement of $2500 to $5000 a month - again -how many people have this amount to pay and then still have income in order to actually enjoy life? There is also no assurance the fees will not increase, or that the entity will still be in business down the road. You are handing over probably the majority of your assets to a company (regardless of whether they claim to be a nonprofit) with no assurance you will receive what you are paying for. Supposedly many of these will "return" as much as 75% of your original investment to your heirs - but if you are single who cares. I would rather use my funds to pay for the assistance I need on my own terms rather than turn over my life savings to one of these places.
29
@dairyfarmersdaughter
I am still intrigued by the plans mentioned in the article because not all of the plans are as expensive as the first one cited. Paying for assistance on your own terms can drain savings too. I would think a group-based plan that provided consistent care would work better. But then again there have been problems with once solid long-term health insurance plans too.
11
I think what's even more interesting is how few comments are made on this article . . . we are a nation of non-planners, dwindling Social Security funds and only the young, bright and shiny new objects get the attention and their tution paid for.
I'm guessing we will have to foot the bill for a home down payment for these millennials, too?
Any politicians interested in talking about the aging populations? Age discrimination? Unconscious bias with age? Or am I the only one who's hearing, seeing and reading about those in their 50's to have no career options left? Increasing cost to retire? To age with dignity?
19
@LRC
Any intelligent-but-ambitious politician who looks at the demographics is not going to like what they see: a problem that cannot be solved by throwing money at it, and cannot be solved by scolding the other political tribe.
And it's been this way for decades. Too many seniors needing services who are too spread out to be served by the available help, at any pay rate. Below a certain population density, travel time to and from seniors' homes eats too much of the day. All the money in the world can't make point A closer to point B.
I'm not even two hours from NYC, the population density here is a somewhat suburban 350 per square mile, and the shortage of home help is a longstanding problem.
So imagine what it's like in the 40+ other states with lower population densities than 350 per square mile.
12
On paper many of the solutions look better than just how they play-out. One can't rely on peer friendship/connection as when one person becomes more medical compromises these friends seem to 'go poof'. Unfortunately, often times the only way to buy social interaction is to hire 1:1 companion. In my area this would cost about 12-25 an hour. Lower paid for simple chit chat and higher for more holistic educated experienced person.
But even without this social phenomenon, I'm not a big fan of any CCRC. As its always far more expensive than what can be arranged by a senior advocate, social worker, family, friend, proxy or navigator or the like
14
Also those fees could pay for several years of part time individual personal care level assistance, keeping someone out of a nursing home for even longer.
9
I'm 85 and last year I was diagnosed with Parkinson's. Of course
I look at the future in this cold-hearted country (as some one described our country) I'm not sure I can afford the future. And I suspect this is the lot of many Americans.
50
What about the loneliness issue we just read about.
21
I wonder about the financial stability of these types of organizations. My parents' assisted living facility changed hands at least three times in the 10 years they lived there. Because the facility was newly renovated and licensed when they moved in, and fully occupied, most changes were without much impact, other than turnover of staff. But on one occasion there were financial issues, and of course the monthly fees kept going up. It strikes me that if there is no building at issue it would be relatively easy for an organization to fold and move on, leaving the subscribers without recourse.
37
In my old age , when my body and mind will not be there to support me , I would rather exit this life with dignity .
We need politicians , ethicists and religious zealots to allow laws for auto determination of our departure from this life .
I don’t want to become just a “ body “ to be taken care by strangers ,using all means to keep me alive , when I am dead inside .
Beside the cost of such care is astronomical and often a burden to the society .
This money can be spent to provide better future for younger generations.
65
@inter nos Agree! I'm 47 and I think about how I will age and the reflection is based on my experiences thus far with my aging parents. I'm of the sandwich generation where there's stress raising children and stress caring for aging adults. There's this emphasis on the millennials and younger people -- that's great -- but what about the aging? Politicians are talking about wiping out student debt. What are we doing about those who have limited ability to work and have paid their dues to the dwindling social security? The prospects are frightening.
14
@inter nos There are 10 states that allow the death with dignity you desire. California, Colorado, District of Columbia, Hawaii, Montana, Maine (starting January 1, 2020), New Jersey, Oregon, Vermont, and Washington. As progressive matters go in this country, don't expect to see support in red states or regions controlled by extreme evangelicals.
22
One caveat about the "age in place" concept: The social component is sometimes difficult to address. My aged father was physically healthy, but after his wife of 70 years passed away, he became withdrawn, reclusive and poorly functional. (Wouldn't consider antidepressant medication). Our plan to have him "age in place" fell apart, despite heroic family intervention and visiting. We eventually had to use an assisted living community with a heavy social interaction emphasis. Not all plans work out.
50
This article implies Medicare and Medicare supplement will help with costs if person has to move to a facility. They do not pay for custodial care, which is what most people need when they can no longer live independently in their own home.
29
Beware of CCRCs!
My mother paid a very handsome buy-in to get an apartment in an independent-living section. By contract, her heirs are entitled to a portion of that sum upon her death or the transfer of the apartment to a new resident, whichever comes first.
Eventually, her health declined to the point where she needed to move to the nursing home section, one of the great selling points of a CCRC.
We have just discovered that the entire CCRC has been mismanaged. It is effectively bankrupt, although not bankrupt enough to stop paying very high salaries and perks to management.
The Department of Health has stepped in....finally. The local politicians are trying to get up to speed on this calamity. Where have they been while funds were being drained, and new revenue had failed to appear??
Don’t believe the advertisements and promotions. They are a crock of soup, celebrity endorsements notwithstanding.
60
Ah, the actuaries have this all this figured out. For profit elder health care is a slippery slope we will all have to navigate. Seems the contractual promise needs rigorous oversight, though or else these companies have the funds upfront.... should be on a monthly or yearly basis.
10
There is a growing continuum of options for people as we age. Ashby Village in Berkeley, CA, Newton@Home in Newton, MA, and Beacon Hill Village, Boston, MA offer a range of free services in exchange for a reasonable annual membership fee. These are attractive to elders who prefer to remain in their own homes and are healthy enough to do so with some meaningful support. It is heartening that the continuum is continuing to grow, with important gaps being filled in by nonprofit and for-profit organizations. I personally prefer nonprofit entities, but some for-profit entrepreneurs can contribute creative ideas to make aging a more manageable, enjoyable, safe time of life.
25
RN and SW case managers assist hospitalized adults suddenly thrust in a crux of having nothing and nobody. Much of the time their situation is not sudden, but they didn't plan for aging. Often the lack of planning was due to caring for ill spouses or even children.
This article offers a delightful model that may become more prevalent and more funded as older adults land in hospitals with no SAFE discharge plan.
Who will pay will become key here during the silver tsunami of the next two decades.
Medicare DOES NOT pay for any form long term care. It will pay for home health RN, SW, PT but in limited quantities for a limited time. It will also pay for short term skilled nursing homes IF a patient is rehabilitative.
Most chronically ill seniors need incrementally more custodial (bathing, toileting, food prep) support as they age. They are rarely safe alone. Consider that 30% of seniors will develop dementia if they live long enough.
Caveat emptor with long term care insurance plans. Again, very few people plan to live long enough to pay for these when they are young and the plan is affordable.
From my perspective planning for aging is as important as planning a family. Both required dedication and strategy for success.
33
The article makes it sound so fantastic. I surely hope this is all so wonderful, but somehow the jaded side of me keeps saying, what's the catch?
So, I checked out long-term care policies some years ago. After going through the fine prints, I've decided against it. The deductibles are high, it has lifetime coverage of only 5 years, and the coverage amount isn't even that high. After some calculations, I figure, even with the pre-tax deductions and employer's chipping in, it's just not worth it. With even reputable insurers quitting LTC policies, I doubt it's becoming better.
As other readers have pointed out, you pay upfront, hoping the CCRC outfit will still be there, with on-campus service as good as advertised, but none of these can be guaranteed. I have family friends, selling their house and move into a retirement community that turns out not as advertised (property in disrepair, services unreliable), but are now stuck with this option since they paid everything upfront, there's no backing-out now.
There is no free lunch this world or next. It requires continuous vigilance, both by ourselves (if we're still able) and families (if we have any). Otherwise you'll forever be at the mercy of others. It's sad, but true.
68
It's a very interesting article, but Ms. Basso's case isn't the ideal example because her episode was covered by Medicare. Medicare covers surgery, after-care, rehab hospital time and physical therapy. (though she may ave received better coverage through the continuing care program.) What Medicare wouldn't have paid for is the aide to help her with shopping and laundry after she returned home -- but that was the least expensive part of the services she needed.
Medicare does a pretty good job covering episodic illness - including rehab to some degree. What it doesn't cover is long term degenerative illness where someone needs nursing care at home. That is the thing that is so hard to insure for.
My only worry about organizations like this is that they are essentially functioning as long-term care insurance without the financial backing of insurance companies. Even some very large long-term insurance operations have gone bankrupt when they miscalculated future expenses -- continuing care arrangements like this face the same financial risk if too many of their patients end up with dementia.
48
Something that is overlooked in discussions about staying in your house is the continuing need for maintenance and repairs. In addition, surprise problems can cost thousands.
60
This is a very interesting article on the stay at home option of a CCRC. Good job NYTimes for publishing this article. I will check into it in Orange County, CA.
Like other retirees or recent retirees (5 years like me), we have examined long term care insurance in the past and heard about many unflattering stories such as escalating monthly payments or insurance companies going out of business after paying for policy for many years.
We have also looked at CCRC's and found the entrance fees prohibitive. So, this stay in home option of a CCRC may well be a nice compromise.
21
Am glad Ms. Basso found support which affords peace of mind. The virtual CCRC seems a promising model, perhaps premised on a somewhat flawed foundation.
I say that as I helped a parent with the selection of a 'luxury' CCRC - and thereafter provided a support 'lifeline'.
Regarding reader questions on CCRC financial viability... any operator around for any length of time - whom keep their CCRCs reasonably full - will be making money hand over fist. Your money is used for investments and expansions (your 'buy-in', whether refundable or not), your monthly fees cover operating expenses.
As for the CCRC itself, it's a corporatised environment (especially a for-profit). Those corporate drones and ladder climbers you once worked with/for - the same types will now dictate your living environment - and care. If single, good luck if things go wrong as there's no partner to advocate for you (have seen this often), and your children will be out of the loop because you didn't want to 'trouble them' (and the CCRC has no contractual obligation to them).
Within the 'care centre', things seem to go well for couples with an able-bodied husband - or for able-bodied single men, otherwise not so much. If not in the previous categories, care and resources seem to be rationed on how 'viable' the CCRC thinks you to be, or how much you/your family wishes to spend over the 'baseline' CCRC care standards.
Resources are allocated; your 'go-to' person can leave; this is not a replacement for family.
15
@Gregitz -
'this is not a replacement for family.'
Not everyone has family, you know.
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@JoanP
Nearly everyone at the community my family member was at had children. What struck me was one couple ‘celebrating’ their 50th wedding anniversary... surrounded by people whom they hadn’t known for more than a year or two, with staff members dashing about taking photos. None of the couple’s three children were present. It all seemed rather empty and false, and I found that profoundly sad.
People have different life circumstances and social capabilities/circles, but entrusting one’s well-being and living situation to large organisations, whether for-profit or non-profit, is for most people not a fantastic strategy. I’ve worked in several large organisations - and also seen the CCRC animal up-close. Large organisational dynamics prevail, employees aligned with organisational goals succeed. If your interests as a resident run counter to those of the organisation, things will not go in your favour. Some administrators can talk a good game though.
For most people, no one is going to be more vested in your well-being than a close family member. Sadly in America, just as people have outsourced their parenting, in kind their children now outsource caring responsibilities for ageing parents.
The whole experience was eye-opening. I too followed the above model, yet came away a changed person. Oh - my family member whom I took out of the CCRC is still with us, whilst many we knew at the CCRC are not. There doesn’t seem to be much longevity once one ends up in the care centre.
22
@Joan Even if you have family they may be thousands of miles away. You can’t always pick where you can work.
18
If you don't plan your retirement and aging needs who will? People with insurance have more money for better care and in many cases can stay at home longer.
* The Federal Deficit Reduction Act provided for every state to have a Partnership program to provide asset protection for those who buy qualified long term care insurance policies. https://www.partnershipforlongtermcare.com
* An alternative are linked products, Life Insurance or Annuities with long term care riders, popular with people that have high net worth. In most states you can also use your qualified money (IRA/401k) to fund your plan. https://www.lifeinsuranceltc.com
Some companies have a cash option you can pay family and friends for care.
3
I suppose Paula felt honor-bound to discuss both programs in this piece, but it muddied the water. The majority of comments as of 10:30 am on Sat are complaints about all-inclusive, total life care developments.
The lead the first part of her column indicated the info to come was about how to stay in your own home.
OK, so back to those “atypical” stay-in-your-home CCRCs: There are fairly low-cost stay-in-home programs to assist with medical issues. There also is the Villages Movement which offers help with other age-at-home needs.
The two approaches deserve their own, separate reporting and information.
And for those who do not have a Village nearby, you can help create one! You are definitely going to find you’re not alone in wanting one!
27
The idea of extra help sounds great but beware of entrance fees, what they cover and how the fees go up each year. Read your contract very carefully.
In 2018 I moved to a non profit CCRC center in Southern Pines NC; I had a cottage and my dogs and cats were allowed. It was a much higher entrance fee than quoted here and monthly fees were 4K plus. Everyone was very nice but it just wasn’t for me.
The center advertised that they took you places but with a few exceptions of dinner once a month (divided into Women or couples), a play or symphony, we went only to doctors. They would go out during the day time, rarely evenings (except the Symphony) and never on weekends.
I left after a 14 months. I’m still waiting for my cottage to be rented so I get my money back. The center makes interest on my money, a large sum; meanwhile I am allowed to visit friends but am told not to eat there even though I pay for meals.
Yes it was nice. However I can pay people to help me, drive me, and pay my mortgage for less than 4K Plus.
I’m 68 and I have MS. But I love living in my own home.
122
@Tommy B. McDonell
Thank you so much for your comment. I'm researching alternatives for my in-laws in the mid 80's. There is such a lack of vision, and absurdly high level of greedy in this country, that 5 the quality of life for everyone, regardless of age, is decaying rapidly. Just read millienals death rate and health issues are declining in alarming numbers.
12
There are places to find information and there is a list of the best places. However evaluation of these places is difficult. Where I lived they had independent living, assisted living and nursing care. How the last two were evaluated effected the first ones evaluation.
The head of where I was thought that people in their 60s should move in which I think is ridiculous.
If you google me I’m an artist in NC and I can try to discuss things you might think about.
T
10
Jeepers, I’ve had stretches when I could have used a “care navigator,” while recovering from injury or illness alone, for months at a time. This sounds like a perfect program for my declining years. I could even keep my dogs. But of course there is nothing like that available here, and if it was available it would be five times the cost because...California. Maybe I should plan to move to Florida?
15
@Passion for Peaches Highly recommend you check with your local Area Agency on Aging. They can confirm what is available and help you find agencies and groups who may well be working on such a program. Don’t give up! You are surely not alone in being interested and wanting such a service.
15
I live in a lifecare community. It was a big decision, but not one I regret due to the sense of well being and security I have that I will be taken care of for the rest of my life. I investigated this option for 6 years. Yes, there are pros and cons, but for a single person the pros outweigh the cons. My home is well staffed with caring people, and I have already benefited from the medical options of skilled nursing after major surgery. it is expensive, but well worth it to me.
23
@Judy
It's expensive and completely out of reach for the core/backbone middle class in this country. All seniors, and all age groups, should have access to quality healthcare in this country. Instead, we are devolving into a cold-hearted, brutal third world country. There are seniors in great financial stress that are taking their own lives as they see no other alternative.
79
@Becca Helen Totally agree with you. There is no such program where I was living in a rural community. I don't know if this programmed existed in 2005 but reading about the cost of the entrance fee, my parents would never have qualified just as they didn't qualify for most of the programs through the Area on Aging Agency due to being over income by a few hundred dollars. It is so difficult to piecemeal a quality of life for our elders and why does it have to be this way?
31
@Judy Which one? We live in Bay Area and have looked at some.
2
Like other similar programs, this one will take care of an elder person reasonably well. However, like most other programs, it does absolutely nothing for an elder without any savings or other funds. So once again, those people eventually die alone and in pain.
31
Rip offs from beginning to end. One nearby me charges well over $4,000.00 per month for basics and has minimal services.
27
I looked at a facility here not long ago. It was one that guarantees to take care of one the rest of one's life regardless of future finances. After paying a fee of 180,000, I could take an apartment and would be paying about 3000 a month for it. That covered utilities, maintenance, etc. They had independent living, assisted living, and skilled nursing care. It was a non profit and, from the data presented, was very fiscally sound. For a person alone, who could afford it, it looked like a good answer for lifetime security. For me, it would not work well for my much younger wife. Once I pass away and her income declines, she could well have had trouble making the monthly fee, and her savings would have been diminished by the fee. But according to what they said, my wife would have stayed right there the rest of her life even if she had become broke. If I were alone, I would seriously consider entering this facility here in my state. But I'm uncomfortable about my wife becoming a possible charity case with this institution in the future.
31
Yes, one of the many options. Seems too expensive for most, however. Family, friends, and neighbors can also be very helpful -- without the associated fees discussed here. Those can easily become the "retirement community" that comes to us at our own homes. It takes some arranging, but "love thy neighbor" (+ family & friends) is a rule to live by! When the time comes for more assistance in order to stay home, the "community" will already have been formed because of your foresight!! -- Transportation is a major issue, but it now becomes easier with Uber and Lyft to help.
24
@Rea L.Ginsberg :
Maybe for those lucky enough to have close relatives nearby, but how many of us have those? And of those that do, how many have relatives willing to care for you, do your laundry, grocery shopping and take you to the doctor?
24
@Rea L.Ginsberg, um...you totally missed the point. The woman featured has children who could have cared for her, but she did not want to burden them the way she had been burdened. Choosing the home care program was an act of generosity toward them, in that regard. Why depend on friends and family if it is not necessary? That’s selfish.
22
@Passion for Peaches
“Why depend on friends and family if it is not necessary? That’s selfish”
Wow - after what I’ve experienced personally (and still now caring for a parent after taking them home from a CCRC), I couldn’t disagree more.
I don’t see how family helping and caring for one another amounts to selfishness, although sadly it’s an idea that seems to be pushed in America by those whom can profit from it. Most other societies - included those with developed economies - don’t have this rather peculiar mindset.
For those not wishing to ‘burden’ their families - but having financial resources - there will always be someone there happy to profit from a lack of connection between family members. It’s all marketed as ‘independence’.
8
The entire industry is completely dysfunctional and greedy. Have no faith! Don't count on them to be there when you finally need them as they've already spent your money.
25
This is great information. The Times should stay on top of this subject given our aging population and the great personal desire that humans have to stay as independent as possible. Living in San Diego, California I see this problem frequently.
42
As an occupational therapist and a certified aging-in-place specialist(CAPS), I would hope that the in-home CCRCs are sending qualified professionals into client's homes to assess how safe their home really is.
There was no mention of whether adaptations would be paid for by the CCRC so that someone who develops mobility or self-care limitations can stay in their home, or if they will be required to move into the CCRCs facilities.
I highly doubt that 24/7 aides are provided, meaning that people may be forced to leave their home anyway. The difference between leaving your home and remaining safe and independent can often be the degree of accessibility and ease your home provides. Aides aren't the answer for long-term problems, and living in a facility is exactly what these clients are trying to avoid.
The entrance fee is low enough that many older adults could afford some adaptations in their home so that they really can stay at home longer. Once the decisions are made for you by the contract you have signed, your freedom is curtailed.
Find a qualified professional to help you stay safe and independent at home, but realize that saying "never-ever" is a wish, not a promise.
71
@Cathy Great suggestions.
11
Sounds great except for the initial fees which are ridiculously high. What if you pay a 5-6 figure entrance fee, then the organization goes bankrupt years later ? Or you pay that huge entrance fee but never use the CCRC because you die suddenly ? Too much financial risk for my tastes.
82
@c-c-g I am a retired lawyer. Bankruptcy of the provider is the first thing I think of when I read of these aging in place arrangements. I live in Virginia. An aging in place community nearby charges entrance fees ranging from $600,000 to close to a million dollars depending on the size of your apartment. Then for a one bedroom they charge $3,000 a month in rent. I could afford the midrange, but I would never do it, thinking of being 80 years old when the company goes belly up and having to find a place to live with the necessary support after my nest egg has been decimated. No way!!
23
What a scam! How can these organizations be considered "non profit" given the description of the "fees" in this article? In addition they are admittedly unaffordable for the vast majority of seniors.
72
The woman who is the subject of this article needed open heart surgery immediately after signing up, yet was accepted into a program that required certification of good health?
Second remark: You are still going to leave home when you become dependent!
And you still pay upfront. The sole advantage of this over traditional CCRC is that your home substitutes for your independent unit on campus.
All this to avoid a nursing home.
My parents are in a CCRC and I cannot believe nursing homes are worse than the health care unit there. They don't even let prospective customers look at it when they visit.
35
@Repatriate Is it a profit-making chain one or a non-profit one? The non-profit ones seem to be better.
7
@Chelmian It is a non-profit, and they must pay less than some of the more expensive new ones so the aides in health unit come and go frequently.
9
@Repatriate, I assume she needed surgery because she had a heart attack. That doesn’t mean she had a necessarily had a history of heart disease.
It does bother me that the care program can cherry pick their clients, though.
10
The At Home programs are a wonderful option for individuals who have made the decision to remain in their homes. We need more of them across the nation. Thank you NY times and Leading Age for FINALLY giving these programs the recognition in the Senior Living Industry that they deserve!
25
So much of what makes a CCRC work well is the staff, from primary caregivers to top management. I've seen facilities functioning well and then, for whatever reasons, key people quit. There can also be cultural differences between providers and residents. It a big challenge to find an eldercare community where most things work well over the long term.
36
Does anyone ever look into the finances of these care facilities, who take houses, condos and coops as payment? How often do they make far more than needed to pay for housing and care?
65